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Patterns and Outcomes of Nonoperative Management of Abdominal Trauma With Solid Organ Injury Among the Pediatric
Mohammed H Kazkaz1, Hussain A Al Ghadeer2, Othman Almohammedsaleh3
1Pediatric Surgery, King Fahad Hospital, Al Hofuf, SAU.
Insights
Nonoperative management (NOM) is highly effective for pediatric solid organ abdominal trauma, with a 94.4% success rate. This approach is crucial for managing injuries from road traffic accidents in children.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Emergency Medicine
Background:
- Trauma is a leading cause of death and disability in children globally.
- Abdominal trauma is a significant cause of pediatric morbidity and mortality, with missed injuries being a major concern.
- Advances in pediatric trauma care have been made, yet challenges remain in managing abdominal injuries.
Purpose of the Study:
- To evaluate the effectiveness of nonoperative management (NOM) for pediatric solid organ abdominal trauma.
- To assess patterns, clinical characteristics, and outcomes of NOM in children with abdominal trauma.
- To determine the success rate of NOM, transfusion requirements, injury severity, and hospital stay.
Main Methods:
- Retrospective chart review of pediatric patients with solid organ abdominal trauma.
- Data collected from King Fahd Hospital, Saudi Arabia, between 2015 and 2020.
- Analysis of patient demographics, trauma mechanisms, injured organs, management, and outcomes.
Main Results:
- 90 children with solid organ abdominal trauma were included; 95.6% sustained blunt trauma, often from road traffic accidents (RTAs).
- The spleen and liver were the most frequently injured organs.
- Nonoperative management (NOM) achieved a high success rate of 94.4%, with only 5.6% requiring surgery. Most patients were discharged within a week.
Conclusions:
- Blunt abdominal trauma, particularly from RTAs, is common in pediatric patients.
- Nonoperative management (NOM) is a highly effective and recommended approach for stable pediatric patients with solid organ abdominal trauma.
- NOM should be considered the standard of care for pediatric solid organ abdominal trauma due to its high success rate and favorable outcomes.
Abstract:
Background Trauma is the leading cause of mortality and long-term disability among children older than one year in the United States and globally, including Saudi Arabia. Abdominal trauma ranks as the third most common cause of trauma-related death in children and remains a significant contributor to morbidity despite advances in pediatric trauma care. Missed abdominal injuries, in particular, represent a major source of preventable morbidity and mortality. Objective This study aimed to assess the patterns, clinical characteristics, and outcomes of nonoperative (conservative) management (NOM) in children with solid organ abdominal trauma, with success rate as the primary outcome and transfusion requirement, injury severity, and hospital stay as secondary outcomes. Materials and methods A retrospective chart review was conducted at King Fahd Hospital, Hofuf, Al-Ahsa, Saudi Arabia, encompassing all pediatric patients with solid organ abdominal trauma between 2015 and 2020. Extracted variables included age, sex, mechanism, type of trauma, injured organs, severity of injury, management approach, and hospital length of stay. Results Ninety children met the inclusion criteria. The mean age was 7.1 ± 3.6 years, with the majority (55.6%) aged 5-10 years. Males predominated (67.8%). Blunt trauma was reported in 95.6% of cases, most commonly due to road traffic accidents (RTAs). The spleen and liver were the most frequently injured organs. NOM was successful in 94.4% of cases (n=85), while only 5.6% (n=5) required surgical intervention. Most children were discharged within one week of admission. Conclusions Blunt abdominal trauma, primarily from RTAs, was the predominant mechanism of injury in the pediatric population studied. The spleen and liver were the most commonly affected organs. NOM was highly effective, reinforcing its role as the standard of care for stable pediatric patients with solid organ abdominal trauma.
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